DISC EDEMA Working Towards The Cause

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DISC EDEMA Working Towards The Cause

• Prof. V. RAJARAM
• Sri Balaji Medical College
• Chennai.

Presentation at CME on Neuro-ophthalmic
Disorders. at Regional Institute of
Ophthalmology and Government Ophthalmic
Hospital, Chennai. September 16, 2006.
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HISTORICAL INTERESTFUNDOSCOPY

• 1704-Jean Merry- Animal Experiment
• 1847-Charles Babbage- 1st primitive
  Ophthalmoscope
• 1851- Von Helmholtz- Clinically useful
  Ophthalmoscope
• 1860- Von Grafe- Reported disc changes in brain
  Tumour
• 1908-Parson coined the term Papilloedema
• 1911- Paton Holmes differentiated Papilloedema
  from papillitis

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CLUE

• More changes in the disc- think of neurological
  problem
• More changes away from the disc with less or no
  changes in the disc Think systemic or Intra
  ocular problems

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FUNDUS NEUROLOGICAL INTEREST

• Papilloedema
• Papilitis
• Primary Optic Atrophy
• Sec. Optic Atrophy
• - Post papilloedemic Optic
  Atrophy
• Post Neuritic Optic Atrophy
• Glaucomatous Optic Atrophy
• Consecutive Optic Atrophy

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PAPILLOEDEMA

• PAPILLOEDEMA DISC OEDEMA
• All disc oedema are not PAPILLOEDEMA
• PAPILLOEDEMA is a passive bilateral non
  inflammatory non ischemic disc swelling
  associated with increased intra cranial tension
  and normal vision with or without correction in
  the early stage

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PATHOPHYSIOLOGY OF PAPILLOEDEMA

• Increased ICT
• Trasmitted elevated CSF pressure in the sub
  arachnoid space around the optic nerve
• Interrurpted orthograde axoplasmic outflow
• PAPILLOEDEMA

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ICT WITHOUT PAPILLOEDEMA? POSSIBLE

• Unilateral POA with contralateral PAPILLOEDEMA -
  Foster-Kennedy Syndrome
• When there is preexisting
• bilateral optic atrophy
• - congenital or acquired
• arachnoid sheath disorders
• - opto-chiasmal arachnoiditis

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HOW TO DIAGNOSE- PAPILLOEDEMA

• EARLY PAPILLOEDEMA
• - Hyperemic Disc
• ( Telengectasis)
• Indistinct margin
• - Splinter Hge at or just off the
  disc margin
• - Absence of spontaneous venous pulsation

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ESTABLISHED PAPILLOEDEMA

• Disc margin more indistinct
• Cup filled
• Disc elevated more than 3D
• Venous engorgement and tortuous
• Flame shaped Hge around the disc

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CHRONIC PAPILLOEDEMA

• DISC elevated pale in appearance
• Margin blurred
• Hges and exudates gradually resolve

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ATROPHIC PAPILLOEDEMA

• Dirty white appearance of the disc
• Reactive gliosis from the disc
• Attenuation and sheathing of peripapillary part
  of the vessels

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DIFFERENTIAL DIAGNOSIS OF PAPILLOEDEMA

• PSEUDO PAPILLOEDEMA
• - High Hypermetropia
• - Cong disc anomaly
• - Drusen optic nerve head
• Hypertensive retinopathy
• Diabetic retinopathy
• Papillitis

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Distinguish
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INVESTIGATION

• Visual acuity
• Pupillary reaction
• Visual fields
• EOM
• FFA- In doubtful cases Pseudo-papil
• BP

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INVESTIGATION-(CONTD)

• CT/MRI
• If SOL seen refer to Neurosurgeon
• if no SOL do LP and CSF analysis

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OPTIC ATROPHY

• OPTIC ATROPHY WILL HAVE PALE DISC BUT NOT ALL
  PALE DISCS ARE OPTIC ATROPHY

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Thank You